Of all the short-term fixes to the federal Medicare program now under consideration in Washington, only a prescription-drug benefit would have much lasting effect, three former Medicare chiefs say.
Appearing together at the University of the Sciences in Philadelphia last week, former HCFA administrators Gail Wilensky, Bruce Vladek and Nancy-Ann DeParle said a wide-ranging overhaul of the system is not urgent and instead called for a long-term, phased-in approach to Medicare reform.
The three are the most recent predecessors to current CMS Administrator Thomas Scully. HHS Secretary Tommy Thompson changed the name of the Medicare agency in 2001.
The panelists agree that the current Medicare system is based on "the normal health plan of the 1960s," according to Wilensky, in that it does not provide catastrophic coverage nor does it pay for outpatient prescription drugs.
"What should Medicare look like in 2010?" asks DeParle, referring to the year baby boomers are expected to start retiring en masse. "It should be modernized. It should not look like a 1965 health plan," she responds.
"The urgency about the trust fund solvency (that dominated political debate last decade) has dissipated a bit," DeParle adds.
DeParle instead calls for a three-phase reform plan. The first phase, from now through 2005, should involve a shift toward competition in fee-for-service Medicare and efforts to help healthcare providers adopt clinical information technology that would improve patient safety.
DeParle contends that most of the medical errors that the Institute of Medicine spells out in its 1999 treatise on the subject, "To Err Is Human," were happening to Medicare patients because the IOM relied on hospital data to conclude that safety lapses cause 44,000 to 98,000 preventable deaths annually.
In the second phase, 2005 to 2008, DeParle says that federal officials should add a prescription drug benefit to Medicare, cap out-of-pocket expenditures for beneficiaries who need catastrophic care and conduct large-scale demonstrations of "new ideas and new types of health plans."
According to DeParle, "I confess that I seriously doubt it will work in a big way, but let's try it."
Not until the final phase, 2008 until 2010, should CMS change other benefits for Medicare recipients, DeParle says.
The others largely concur on the broad idea of incremental reform but offer different ways of implementing changes.
"Demos have not brought all the people into the new project," says Wilensky. "We need to provide better information about quality and patient safety."
And, says Vladek, Medicare is too complex at the moment to dive headfirst into a complete overhaul. "Let's figure out the system, and then we can figure out how to pay for it," he says.